U.S. patent number 4,740,103 [Application Number 06/702,291] was granted by the patent office on 1988-04-26 for intravenous system for delivering a beneficial agent.
This patent grant is currently assigned to ALZA Corporation. Invention is credited to Felix Theeuwes.
United States Patent |
4,740,103 |
Theeuwes |
* April 26, 1988 |
Intravenous system for delivering a beneficial agent
Abstract
A formulation chamber is disclosed comprising a wall surrounding
a lumen containing a device for delivering a beneficial agent. The
chamber has an inlet for admitting a fluid into the chamber and an
outlet for letting an agent formulation leave the chamber. The
chamber is adapted for use in an intravenous delivery system for
delivering an agent formulation to a patient.
Inventors: |
Theeuwes; Felix (Los Altos,
CA) |
Assignee: |
ALZA Corporation (Palo Alto,
CA)
|
[*] Notice: |
The portion of the term of this patent
subsequent to March 27, 2001 has been disclaimed. |
Family
ID: |
26977173 |
Appl.
No.: |
06/702,291 |
Filed: |
February 15, 1985 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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310047 |
Oct 9, 1981 |
4511353 |
Apr 16, 1985 |
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283077 |
Jul 13, 1981 |
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Current U.S.
Class: |
604/83; 604/251;
604/84; 604/85; 604/892.1 |
Current CPC
Class: |
A61M
5/1407 (20130101) |
Current International
Class: |
A61M
5/14 (20060101); A61M 005/14 () |
Field of
Search: |
;604/83,84,85,80,81,56,251,252,416,890,892 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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497181 |
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Sep 1969 |
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CH |
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982107 |
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Sep 1963 |
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GB |
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Other References
Paxinos, J. and Samuels, T. M.; Am. J. Hosp. Pharm., vol. 32, pp.
892-897, Sep. 1975. .
Goodwin, H. N., The American Journal of I. V. Therapy, pp. 27-30,
Dec.-Jan. 1975. .
Masson, A. H. B., Brit. J. Anaesth., vol. 43, pp. 681-686, (1971).
.
Ferenchak et al., Surgery, vol. 70, No. 5, pp. 674-677, Nov.,
1971..
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Primary Examiner: Phillips; Delbert R.
Assistant Examiner: Nutter; Nathan M.
Attorney, Agent or Firm: Sabatine; Paul L. Mandell; Edward
L. Previcale; Shelley G.
Parent Case Text
CROSS REFERENCE TO RELATED APPLICATION
This application is a division of copending patent application U.S.
Ser. No. 310,047, filed on Oct. 9, 1981, now U.S. Pat. No.
4,511,353 issued Apr. 16, 1985, which application is a
continuation-in-part of patent application U.S. Ser. No. 283,007
filed on July 13, 1981, now abandoned, which applications are
incorporated herein by reference and benefit is claimed of their
filing date. This application is copending with an application
identified as ARC 801 CIP, now Ser. No. 312,491 filed Oct. 19, 1981
issued U.S. Pat. No. 4,552,555 on Nov. 12, 1985. All of the
applications are assigned to the ALZA Corporation of Palo Alto,
Calif.
Claims
I claim:
1. An intravenous delivery system for administering an agent
formulation to a patient comprising in combination:
(a) a reservoir of a pharmaceutically acceptable liquid;
(b) an agent formulation chamber comprising:
(1) an inlet that communicates with the reservoir to permit the
liquid to flow from the reservoir into the chamber, and
(2) an oulet through which the liquid exits the chamber;
(c) a rate-controlled dosage form of the agent in the chamber and
in communication with the liquid flowing through the chamber, which
dosage form releases the agent into the liquid at a predetermined
rate over time; and,
(d) a conduit that communicates with the chamber and extends to the
patient.
2. The intravenous delivery system according to claim 1 wherein the
liquid is an aqueous liquid and the dosage form is an osmotic
dosage form.
3. The intravenous delivery system according to claim wherein the
system comprises a drip chamber that communicates with the
reservoir and the chamber.
4. The intravenous delivery system according to claim 1 wherein the
rate-controlled dosage form release the agent at a rate that is
essentially independent of the volume of liquid flow through the
chamber.
5. The intravenous delivery system according to claim 1 wherein the
system comprises a filter.
Description
TECHNICAL FIELD
This invention pertains to an intravenous delivery system, and to a
drug formulation chamber containing an agent delivery device. The
invention relates also to a method of administering intravenously
an agent formulation, and to a method for forming the agent
formulation.
BACKGROUND OF THE INVENTION
The parenteral administration of medical liquids is an established
clinical practice. The liquids are administered particularly
intravenously, and the practice is used extensively as an integral
part of the daily treatment of medical and surgical patients. The
liquids commonly administered include blood and blood substitutes,
dextrose solution, electrolyte solution and saline. Generally the
liquids are administered from an intravenous delivery system having
a container suspended above the patient, with the liquid flowing
through a catheter hypodermic needle set to the patient.
The administration of liquids intravenously is a valuable and
important component that contributes to the optimal care of the
patient; however, it does not provide a satisfactory means and
method for administering concomitantly therewith a beneficial
agent. Presently, a beneficial agent is administered intravenously
by (1) temporarily removing the intravenous system administering
the agent to the patient followed by reinserting the intravenous
system into the patient; (2) the agent is added to the liquid in
the container and then carried by the flow of the liquid to the
patient; (3) agent is added to a liquid in a separate container
called a partial fill that is connected to the primary intravenous
line through which line the agent is carried by the flow of liquid
to the patient; (4) agent is contained in a piggyback vial into
which is introduced an intravenous fluid, with the vial
subsequently connected to the primary line through which the agent
is administered to a patient, or (5) agent is administered by a
pump that exerts a force on a liquid containing agent for
intravenously administering the liquid containing the agent. While
these techniques are used, they have major disadvantages. For
example, they often require preformulation of the agent medication
by the hospital pharmacist or nurse, they require separate
connections for joining the primary intravenous line that further
complicates intravenous administration, the use of pumps can
produce pressures that can vary at the delivery site and the
pressure can give rise to thrombosis, and the rate of agent
delivery to the patient often is unknown as it is not
rate-controlled agent delivery but delivery dependent on the flow
of fluid administered over time.
In view of this presentation, it is apparent a critical need exists
in the field of intravenous delivery for a rate-controlling means
for administering a beneficial agent in intravenous delivery
systems.
DISCLOSURE OF THE INVENTION
Accordingly, a principal object of this invention is to provide an
intravenous delivery system comprising means for admitting an agent
at a rate controlled by the means into an intravenous fluid for
optimizing the care of a human whose prognosis benefits from
intravenous delivery.
Another object of the invention is to provide an intravenous
delivery system comprising an agent formulation chamber comprising
an agent delivery device for admitting an agent at a rate
controlled by the delivery device into an intravenous fluid for
optimizing the care of a patient on intravenous delivery.
Another object of the invention is to provide an agent formulation
chamber adapted for use with an intravenous delivery system and
which chamber houses an agent delivery device for admitting an
agent at a rate essentially controlled by the device into an
intravenous fluid admitted into the chamber.
Another object of the invention is to provide an intravenous
therapeutic system comprising a container and a drug formulation
chamber that houses a device for delivering a drug at a rate
governed by the device into a medical fluid that flows from the
container into the chamber and then to a drug recipient.
The invention concerns both an intravenous delivery system
comprising an agent formulation chamber and the agent formulation
chamber. The chamber contains an agent formulation, wherein an
agent originally present in a delivery means present in the chamber
is released at a rate controlled by the delivery means. The agent
on its release is formulated in situ with an intravenous fluid that
enters the chamber with the agent released at a controlled rate
that is essentially independent of the volume rate of an
intravenous fluid entering the formulation chamber, and then
infused into a recipient. The expression delivery means, as used
herein, generically denotes a means or a system for storing and
delivering a beneficial agent at a rate controlled by the means to
establish a beneficial or a therapeutic need. The means, is
presently preferred embodiments, are designed and manufactured as
an agent delivery device, which device also is a rate-controlled
dosage form of the agent. The delivery device or dosage forms
stores an amount of agent for executing a prescribed beneficial
program, and it provides for the preprogrammed, unattended delivery
of a beneficially or a therapeutically effective amount of the
agent to produce a beneficial or therapeutic result. The delivery
device, or the dosage form, are adapted for easy placement and
retention in the formulation chamber, and they substantially
maintain their physical and chemical integrity during their release
history. The expression beneficial agent generically denotes a
substance that produces a beneficial or a therapeutic result, such
as a drug, a carbohydrate, and/or the like. The term fluid or
liquid denotes a fluid that can be administered parenterally
including intravenously comprising pharmaceutically acceptable
fluids that are also a pharmaceutically acceptable carrier for the
agent. The invention also is an intravenous therapeutic system for
administering a liquid drug formulation, wherein the liquid drug
formulation is formulated in situ. The intravenous delivery system
generically comprises in combination:
(a) a container for storing a pharmaceutically acceptable liquid
carrier for the agent;
(b) an agent formulation chamber comprising: an inlet that permits
communication with the container to let a liquid carrier flow from
the container into the formulation chamber; and an outlet through
which the liquid exits the chamber;
(c) an agent delivery means in the chamber, which means is a
rate-controlled dosage form of agent that is in communication with
a liquid flowing through the chamber, and wherein when in
operation, the means releases the agent into the liquid at a
predetermined rate that is substantially independent of the volume
rate of liquid flow flowing through the chanber; and,
(d) a conduit that communicates with the chamber outlet and extends
to an infusion recipient site.
The agent formulation chamber generally comprises means for housing
and delivering an agent at a rate-controlled by the means
overtime.
BRIEF DESCRIPTION OF THE DRAWINGS
In the drawings, which are not drawn to scale, but are set forth to
illustrate various embodiments of the invention, the Figures are as
follows:
FIG. 1 is a perspective view showing an embodiment of the invention
comprising an intravenous delivery system in use;
FIGS. 2a and 2b are perspective views of an agent formulation
chamber provided by the invention with the formulation chamber
housing a means for delivering an agent which means is manufactured
as an agent delivery device;
FIG. 3 is a view of an agent formulation chamber containing an
agent delivery device comprising an agent release rate controlling
membrane surrounding a reservoir containing agent;
FIG. 4 is a view of an agent formulation chamber containing a
delivery device comprising a release rate controlling membrane
surrounding a different reservoir containing agent;
FIG. 5 is a view of an agent formulation chamber containing a
delivery device comprising a microporous membrane surrounding a
reservoir containing agent;
FIG. 6 is a view of an agent formulation chamber containing a
delivery device comprising a matrix containing agent;
FIG. 7 is a view of an agent formulation chamber containing an
agent delivery device comprising a microporous matrix containing an
agent;
FIG. 8 is a view of an agent formulation chamber containing a
delivery device comprising depots of agent;
FIG. 9 is a view of an agent formulation chamber containing a
delivery device comprising a housing and driving member surrounding
a flexible container;
FIG. 10 is an embodiment of the invention illustrating an agent
formulation chamber in fragmentary view; FIG. 11 is a sectional,
fragmentary view of the parts of the embodiment shown in FIG.
10;
FIG. 12 is an enlarged, partly sectional view of another
formulation chamber;
FIG. 13 is an enlarged, partly sectional view of still another
embodiment of an agent formulation chamber housing a delivery
device;
FIG. 14 is a graph showing a typical relationship between the mass
rate of agent administration and the volume flow rate of
intravenous fluid to the patient that results from use of the
invention; and,
FIG. 15 is a graph that indicates the time required for the
delivery rate to reach a steady state of delivery.
In the specification and the drawings, like parts in related
Figures are identified by like numbers. The terms appearing earlier
in the specification and in the description of the drawings are
described hereafter in the disclosure.
MODES FOR CARRYING OUT THE INVENTION
FIG. 1 illustrates an operative embodiment of the invention,
comprising an intravenous delivery system, generally designated by
the numeral 10. System 10 comprises a container 12 that contains a
liquid 13 adapted for intravenous administration, and an
administration set, generally designated 14. The liquid 13 in
container 12 will typically be a medical fluid, a sterile solution
such as an aqueous solution of dextrose, saline, and electrolytes.
It must be a pharmaceutical vehicle for intravenous administration
and for an agent that is to be administered to a recipient.
Container 12 is manufactured from glass or plastic, and preferrably
of the no air-tube vacuum type and thus it is used with an
administration set that has an air inlet filter. Other types of
containers such as the air-tube vacuum type, or the non-vented type
can be used for the intended purpose. These alternative containers
do not require an air filter in the administration set. Container
12 can be rigid, semi-rigid or flexible in structure, and it is
usually adapted to be hung neck-down from a hanger 15 by a handle
or strap 16 that connects or surrounds container 12. The neck of
container 12 is covered by a closure 17, generally made of rubber
and air-tight.
Administration set 14 and container 12 are interconnected by
piercing closure 17 with one end of a needle or hollow spike 18
attached to or formed as a part of administration set 14. Needle 18
is equipped with a side air vent 19. The other end of needle 18 is
enlarged and fits snugly into a drip chamber 22. Drip chamber 22
traps air contained in the set and facilitates adjusting the flow
rate of intravenous fluid 13 from container 12 as the flow proceeds
drop wise. The outlet at the bottom of drip chamber 22 is connected
to a first segment of tubing 23 which fits into inlet 24 of agent
formulation chamber 25, the details of which are presented in
subsequent figures. A second segment of tubing 23 connects to
outlet 26 of agent formulation chamber 25 and leads to bacterial
filter 27. A third segment of tubing 23 extends from filter 27 to
an infusion agent receptor site, terminating in an adapter-needle
assembly 28 that is inserted into a vein of warm-blooded animal 29,
shown as a human patient's arm. An affixation means 32, usually a
piece of tape, holds adapter-needle assembly 28 firmly in place on
the recipient's arm. The administration set can also include a pair
of tubing clamps 33 and 34 located on either side of formulation
chamber 25 that may be used to govern or stop the flow rate of
intravenous fluid through the intravenous therapy system.
Agent formulation chamber 25, as seen in FIGS. 2A and 2B, is the
unique component of the intravenous delivery system. Agent
formulation chamber 25 is sized and adapted for use in intravenous
systems, it is self-contained, self-powered and amenable to low
cost manufacturing. The use of the agent formulation chamber with
an agent delivery means therein does not require any reconstitution
or admixture prior to use. Agent formulation chamber 25, hereafter
referred to as chamber 25, in the illustrated embodiment, comprises
a wall 9 that surrounds and defines an internal space 38. Chamber
25 has an inlet 24 adapted and sized for placing chamber 25 into an
intravenous delivery system, and it has an outlet 26 also adapted
and sized for placing the chamber in the system. Inlet 24 and
outlet 26 are made for receiving tube 23. Chamber 25, is
manufactured of glass, plastic or the like, and as illustrated it
is made of a transparent material for illustrating its structure
and a device housed therein. In the embodiment shown, chamber 25
comprises a pair of interfitting housing halves 35 and 36 for
containing agent delivery device 37 within space or lumen 38. A
retaining means 8 in housing 36 permits the passage of fluid, keeps
device 37 in lumen 38, and it also prevents device 37 from blocking
outlet 26. Agent delivery device 37, in the illustrated embodiment
is an osmotic, rate-controlled solid dosage form as described by
patentee Felix Theeuwes in U.S. Pat. No. 3,845,770. The osmotic
device 37, seen in opened section, comprises a semipermeable wall,
37a, such as cellulose acylate, cellulose diacylate, cellulose
triacylate, cellulose acetate, cellulose diacetate or cellulose
triacetate, that surrounds and forms a compartment 37b. A
passageway 37c extends through semipermeable wall 37a and
communicates compartment 37b and the exterior of device 37.
Compartment 37b contains an agent formulation 37d, represented by
dots, which agent formulation exhibits an osmotic pressure gradient
across wall 37a of device 37 against an external fluid that enters
chamber 25. The agent formulation can comprise an agent that
exhibits an osmotic pressure gradient, or the agent formulation can
comprise a drug mixed with an osmotically effective solute, such as
sodium chloride, potassium chloride and the like, that exhibit an
osmotic pressure substantially greater than the fluid in the
chamber 25. In operation, fluid that enters in the chamber 25 is
imbibed through the semipermeable wall of the device into the
compartment in a tendency towards osmotic equilibrium at a rate
determined by the permeability of the wall and the osmotic gradient
across the wall thereby producing a solution that is dispensed
through the passageway at a rate controlled by the device over a
prolonged period of time. The delivery of agent formulation 37d for
homogenously blending with fluid in chamber 25, is controlled by
device 37, and its rate of delivery is independent of the rate of
fluid flow, and the pH of the fluid in the chamber. Device 37
maintains its physical and chemical integrity throughout its
releasing history. In other embodiments, not shown, chamber 25 can
be manufactured as a one-piece unit with the delivery device
therein, or chamber 25 can be manufactured with a closable entrance
for admitting the delivery device. Additionally, another embodiment
of the invention comprises chamber 25 simultaneously acting as a
drip chamber while housing the agent delivery device. In this
embodiment the agent formulation chamber-drip chamber is used to
achieve a desired fluid drop rate. For example, the agent
formulation chamber-drip chamber can have a fast drop rate for
adults, or it can have a slower drop rate for pediatric use. The
agent formulation-drip chamber can be made with various sized
inlets for controlling the rate of drip, or the drip can be
controlled by a regulating clamp on the tubing conveying fluid
thereto. The agent formulation chamber-drip chamber can deliver,
for example from 2 to 75 drops per milliliter over from 1 minute to
1 hour. More preferrably, the therapist can adjust the rate of flow
of 2 to 20 drops per minute, or for the need of the patient.
The rate performance of the delivery devices used in formulation
chamber 25 for the purpose of the invention also can be described
mathematically in terms of the physical and chemical composition of
the agent release systems. Generally, delivery systems encompassed
by this invention are those for which Q.sub.R .ltoreq.0.1Q.sub.KVO,
where Q.sub.KVO is the flow of fluid required to maintain flow into
the veins of an animal in which the flow path terminates, by needle
or catheter. This flow is referred to as the "keep vein open" rate,
KVO, and it typically is for an adult patient about 10-20 drops per
minute, or 0.5-1.0 ml per minute. Q.sub.R is the maximum rate of
fluid flow needed for the delivery system to release agent in
solution at its label rate. Thus, delivery systems for adult use
require less than 0.05-0.1 ml/min to achieve label delivery rate,
and show independence of delivery rate from flow at all higher
flows are encompassed by this invention. Delivery systems for
pediatric use will have a lower absolute limit, but still satisfy
the general criterion of Q.sub.R .ltoreq.0.1Q.sub.KVO.
During operation of device 37 as seen in FIG. 2B, the mass delivery
rate of agent from chamber 25 is given by the volume flow rate F
expressed by equation 1, of fluid entering chamber 25, times the
concentration of agent C.sub.2, in the chamber with a volume
V.sub.2. In the chamber, V.sub.2 is the
volume of the total chamber less the volume V.sub.1 of agent
delivery device 37. In the chamber, it is assumed that lumen
V.sub.2 is stirred by fluid flow to achieve a uniform concentration
C.sub.2. The chamber is designed to produce a steady state mass
flow rate dm.sub.3 /dt, expressed in equation 2 independent of flow
rate F leaving the chamber and conveyed to an agent recipient,
represented by volume V.sub.3. The calculations presented here
are
performed to determine the flow regimen for which the intended end
result can be achieved over time. The calculations are for an
osmotic device, designated as 37, containing a mass of agent m, at
the start of a beneficial delivery program. During operation, the
device delivers at a zero order rate as given by equation (3).
##EQU1## wherein: K.sub.1 is the permeability of the wall of the
delivery device to water, A.sub.1 is the wall area of the device,
h.sub.1 is the thickness of the wall, .pi..sub.1, is the osmotic
pressure of saturated agent solution in the device, .pi..sub.2 is
the osmotic pressure of the solution in the lumen of the chamber at
concentration C.sub.2, and S.sub.1 is the solubility of agent in
volume V.sub.1 in the device. The mass of agent m.sub.2 in the
lumen of the chamber at concentration C.sub.2 is conveyed to the
patient. The patient then has a total amount of agent infused of
mass m.sub.3 such that the mass balance at any time is given by
equation 4.
As a result, the mass change in each compartment, the device, the
chamber and the patient, is expressed by equation 5,
wherein
since
and it follows that ##EQU2## it follows that ##EQU3## From
equations (3), (5), (6) and (10), equation (11) follows: ##EQU4##
where 2 and C.sub.2 are related through Van Hoff's law as shown by
12:
Equations (11) and (12) result in differential equation 13, from
which C.sub.2 follows as a function of time. ##EQU5## and when
equation (14) is substituted therein, ##EQU6## equations (15) and
(16) follow, ##EQU7## and for (16) the solution is given by
equation (17). ##EQU8## Equation (17) indicates the time course in
which C.sub.2 attains its steady state value. The steady state
value is given by 18, with the flow rate ##EQU9## The flow rate
into the patient is obtained from (17) and (2) as equation (19).
##EQU10## Equation 19 leads to (1) the minimum flow rate F.sub.m
needed to achieve a regimen independent of flow, and (2) the time
it takes until the patient receives steady state intravenous
administration. The steady state flow rate achieved with the
infuser is given by equation 20 or 21, ##EQU11## and the maximum
steady state flow rate is the steady state expressed by equation
22,
the delivery rate from the delivery device. The steady state flow
rate as a function of flow F is given by equation 23 ##EQU12## and
graphically represented in FIG. 14, solid line, as a function of
F/F.sub.1, wherein it can be seen at high flow rates F>F.sub.1,
the agent delivery rate from the device is independent of fluid
flow in the chamber.
Generally, the volume flow rates from an osmotic device delivering
at high rates, for example 100 mg/hr, are on the order of 0.05 to
0.2 ml/hr. The incoming fluid rate from a container containing a
medical liquid, and referred to as the drip rates from an
intravenous gravity feed system are in the range of from 1 to 400
ml/hr, and for these two ranges the total mass delivery rate is
within 80 percent of the designed rate at all times.
The steady state rate of equation (20) can be expressed relative to
the non-steady state rate of equation (19) by equation 24.
##EQU13## Under operating conditions, F F.sub.1, equation (24) can
be expressed as equation (25), and ##EQU14## V.sub.2 /F is a
characteristic time of the chamber. It is the time it takes to
clear volume V.sub.2 at incoming flow rate F. These systems are
typically designed such that this time is small to reduce the start
up time, and the dead volume V.sub.2 in the chamber is small
compared to the volume transported in the start up time. The dead
volume V.sub.2 is usually less than 1 ml. Thus, for the minimum
flow rate of 1 ml/hr used in intravenous therapy, the
characteristic time would be one hour. Accompanying FIG. 15
represents the time it takes to achieve any fraction of a steady
state value in units of characteristic time, and generally
indicating 80 percent of the steady state rate is achieved in 1.5
times the characteristic time.
FIG. 3 depicts agent formulation chamber 25, in opened section,
containing another device 40 for delivering an agent into an
intravenously acceptable fluid that enters chamber 25. Device 40 is
illustrated in opened-section and it comprises an inner mass
transfer conductor 41, illustrated as a solid core and formed of a
polymeric material such as cured polydimethylisoxane, with agent 42
dispersed therethrough. Surrounding mass transfer conductor 41 is
an agent release rate controlling membrane 43, preferrably formed
of a polymeric material, such as polyethylene. Both conductor 41
and membrane 43 are permeable to the passage of agent 42 by
diffusion, that is, agent can dissolve in and diffuse through
conductor 41 and membrane 43. However, the permeability of
conductor 41 is greater than that of membrane 43, and membrane 43
thus acts as the rate controlling member for agent release from
device 40. Device 40 maintains its physical and chemical integrity
throughout the period of agent delivery. Agent delivery device 40
is disclosed in U.S. Pat. No. 3,854,480.
FIG. 4 illustrates the agent formulation chamber, with a section of
its wall removed, housing delivery device 44 for delivering an
agent at a rate controlled by device 44 into a fluid that enters
chamber 25. Device 44 is seen in opened-section and it comprises a
reservoir 45 formed of a liquid mass transfer conductor 46 such as
a medical oil liquid carrier, permeable to the passage of agent,
containing agent 47 such as the drug phenobarbital. Reservoir 45 is
surrounded by a wall 48 formed of an agent or drug release rate
controlling material permeable to the passage of agent 47, such as
a polyolefin. The rate of passage of agent 47 is lower than the
rate of passage through conductor 46, so that agent release by wall
48 is the agent release rate controlling step for releasing agent
47 from device 44. Device 44 maintains its physical and chemical
integrity throughout its agent release history. Agent delivery
device 44 is disclosed in U.S. Pat. No. 3,993,073, which patent is
incorporated herein.
FIG. 5 illustrates agent formulation chamber 25, with a part of its
wall removed, housing another device 49 for delivering an agent
into a liquid that enters chamber 25 for forming an intravenously
acceptable agent formulation. Device 49 is seen in opened-section
and it comprises a wall 52 surrounding a reservoir 50 containing
agent 51. The reservoir is formed of a solid carrier permeable to
the passage of agent such as cured polydimethylsiloxane containing
the drug diazepam. Wall 52 is formed of a microporous material, the
pores of which contain an agent release rate controlling medium
permeable to the passage of agent 51, for example, formed of a
microporous polymer made by coprecipitation of a polycation and a
polyanion. The release of agent 51 is controlled by device 49,
which device maintains its physical and chemical integrity during
the period of time it is in chamber 25. Device 49 is disclosed in
U.S. Pat. No. 3,993,072, which patent is incorporated herein by
reference.
FIG. 6 is a view of formulation chamber 25 having part of its
housing removed and housing device 53 for delivering an agent into
a medical fluid that enters chamber 25 for forming in situ an
intravenously acceptable agent formulation solution. Device 53
comprises a matrix 54 containing agent 55 distributed therethrough.
Matrix 55 is formed from a polymeric material that is non-erodible,
that is, it keeps its physical and chemical integrity over time,
and it is permeable to the passage of agent 55 by the process of
diffusion. The rate of agent release from the matrix is determined
by the rate the agent dissolves in and passes through the matrix by
diffusion, so that from the matrix it is the agent release rate
controlling step. The matrix can possess any shape such as rod,
disc and the like that fits into chamber 25. The polymers include
polyolefins such as polyethylene containing muscle relaxants and
the like. Materials useful for manufacturing the devices are
disclosed in U.S. Pat. No. 3,921,636.
FIG. 7 is a view of agent formulation chamber 25, in opened view,
housing device 56 for delivering an agent into a fluid that enters
chamber 25. Device 56 is seen in opened section, and it is formed
of a microporous polymeric material 57 containing agent 58
distributed therethrough. Matrix 57 is formed of a non-toxic, inert
polymer, that is non-erodible and has a plurality of micropores for
releasing agent at a controlled rate to fluid entering chamber 25.
Microporous materials useful for the present purpose are disclosed
in U.S. Pat. Nos. 3,797,494 and 3,948,254.
FIG. 8 illustrates agent formulation chamber 25, in opened view,
housing device 59 for delivering an agent into a medical fluid that
enters chamber 25. Device 59 is seen in opened section and it
comprises depots of agent solute 61 dispersed in and surrounded
substantially individually by a polymer 60 that is impermeable to
the passage of agent solute and permeable to the passage of fluid
that enters chamber 25. Agent or a medication solute 61 exhibits an
osmotic pressure gradient across the polymer against fluid that
enters chamber 25. Agent 61 is released at a controlled rate by
fluid from the chamber being imbibed through the polymer into the
depots to dissolve the solute and generate a hydrostatic pressure
in the depots, which pressure is applied against the wall of the
depots thereby forming apertures that release the agent at a
controlled rate over time. Polymer 60 is non-erodible, and device
59 can be shaped as a matrix, a rod, a disc, or like shapes.
Procedures and materials useful for manufacturing osmotic bursting
delivery systems are described in U.S. Pat. No. 4,177,256.
FIG. 9 illustrates agent formulation chamber 25, in opened view,
containing device 62 useful for delivering an agent into a
medically acceptable fluid passing through chamber 25. Device 62 is
seen in opened view and it comprises an exterior wall 63 formed of
a semipermeable polymer permeable to fluid and substantially
impermeable to the passage of agents and solutes. A layer 64 of an
osmotically effective solute, for example sodium chloride, is
deposited on the inner surface of wall 63. Solute layer 64
surrounds an inner container 65 formed of a flexible material that
is impermeable to solute and agent. Container 65 has a passageway
66 for delivering an agent 67 into a fluid in chamber 25. Device 62
dispenses agent by fluid permeating from chamber 25 through the
outer wall 63 to continuously dissolve solute 64 in a tendency
towards osmotic equilibrium, thereby continuously increasing the
volume between wall 63 and container 65. This increase causes
container 65 to continuously collapse and dispense agent 67 from
device 62 at a controlled rate through passageway 66 to fluid
passing through chamber 25. Osmotically powered agent dispensing
devices are disclosed in U.S. Pat. Nos. 3,760,984 and
3,995,631.
In FIGS. 10 and 11 another chamber 25 provided by the invention is
seen composed of a pair of interfitting housing halves 35, 36 and a
rate controlled solid agent or drug dosage form 37 contained within
the lumen 38 of chamber 25. The chamber inlet 24 is in this
embodiment the cone-shaped of housing half 35, and the chamber
outlet 26 is in the cone-shaped end of half 36. The inside
perimeter of half 36 has a series of downwardly inclined flutes 39
on which dosage form 37 rests. The dosage form is supported by the
flutes above the outlet, and is thus kept from blocking the outlet.
Dosage form 37 is an osmotic, rate-controlled dosage form as
described above and in U.S. Pat. No. 3,845,770, which disclosure is
incorporated herein by reference. In the illustrated embodiment,
dosage form 37 has passageway 37c oriented in the direction of
fluid flow through chamber 25 for lessening the incidence of
membrane polarisation and to produce release rates practically
unaffected by effluent agent. In this operation, the release
pattern is seen in FIG. 14 as represented by the dashed lines.
Another osmotic agent delivery device, not shown, that can be
positioned in chamber 25 is disclosed by patentee Felix Theeuwes in
U.S. Pat. No. 4,111,202, which patent is incorporated herein by
reference. The device of this patent comprises a semipermeable wall
that surrounds a first and second compartment with the first
compartment containing an agent and the second compartment
containing an osmotically effective solute that exhibits an osmotic
pressure gradient across the semipermeable wall. In this device,
the compartments are separated by a flexible membrane, and the
device has a passageway that communicates with the compartment
containing the agent for its delivery from the device. This device,
when in operation, delivers agent by imbibing fluid from the
infuser into the first compartment to form a solution containing
agent, and into the second compartment to form a solution
containing the solute which continuously fill the second
compartment and expands the membrane into the first. The agent is
delivered through the passageway by the combined actions of the
first and second compartments at a controlled rate over a period of
time. For this delivery device, like the device described above,
the mass rate of agent released by the device is substantially
independent of the volume flow of intravenous fluid to the patient
as it is instead controlled by the mass release of agent from the
dosage device. This relationship is shown in FIG. 14, in solid
line. In FIG. 14 the rate of release from the device when
passageway 37c is directed in the path of liquid flow is
illustrated in dashed lines.
Agent administration that is independent of intravenous fluid flow
rate is extremely advantageous since careful control of the volume
flow rate of intravenous fluid through the formulation chamber is
not required. Hence, repeated adjustment of the flow by medical
personnel, or the use of expensive, automated flow monitors is not
needed. The operation also has all the advantages that are
associated with the fact that the formulation of agent and
intravenous fluid is carried out automatically in situ within the
chamber. Moreover, since the chamber can be positioned within the
intravenous therapeutic system when needed, the separation of the
agent and the intravenous fluid until administration provides
significant stability and handling advantages. The present
invention also eliminates the need to have the agent formulated
into a parenteral solution by a pharmacist, and, it also eliminates
the need for the agent to be packaged separately from the
intravenous fluid container. Another advantage provided by this
invention, is since the agent dosage delivery device is compatible
with conventional sterilization techniques that are commonly used
to sterilize intravenous therapy systems, the agent formulation
chamber, including the agent delivery device, may be incorporated
into the entire intravenous system at the time of manufacture and
sterilized therewith.
The invention also provides that agent delivery devices each
containing various amounts of an agent or an amount of drug can be
placed into the formulation chamber. The device can contain from
about 1 mg to 5 g of agent, or more, in for example 1 to 7 or more
dosage units. The device can release agent at a rate of 10 ng/hr up
to 3 g/hr into the chamber having a volume capacity of at least 2
ml up to 250 ml, through which intravenous fluid flows at a rate of
1 ml/hr up to 20 ml/hr or higher. The term drug is represented by
heparin, isoproterenol, and the like.
FIG. 12 illustrates another agent formulation chamber designated
25. In this chamber, the rate-controlled dosage delivery device is
not in direct path of the intravenous fluid flow through chamber
25. In this embodiment chamber 25 includes a pair of hollow
interfitting housing halves 71 and 73. Housing half 71 has an inlet
opening or its cone-shaped end for tubing 23. The inner surface of
half 71 carries a pair of integral flanges 74 and 76 that together
with a thin microporous membrane 70 define an enclosed pocket 75
inside the lumen 72 of chamber 25. An agent delivery device 37 is
contained within the pocket. Device 37 is, as described above, a
complete rate-controlled form and it may additionally act in
combination with membrane 70 to enhance the control of agent into
passing fluid. Such combinations, in which an element of chamber is
used with a delivery device are intended to be within the phrase
rate-controlled delivery as used herein. In such combinations,
membrane 70 can serve as a rate-controlling barrier that regulates
the rate at which the agent enters the mainstream of intravenous
fluid flow through the chamber. Since device 37 is a complete
rate-controlled form, the membrane acts as a supplemental barrier
or as a means for confining the device so that it does not block
the entrance or exit of chamber 25. Membrane 70 permits the passage
of fluid so that as intravenous fluid fills and passes through the
chamber, which flow is represented by the straight arrow in FIG.
12, water from the fluid will diffuse, represented by curved
arrows, through the pores of the membrane into the pocket and
motivate device 37 to release drug. The released agent will pass
from the pocket through the membrane into the mainstream flow
through chamber 25. The rate at which the agent will enter the
mainstream will depend on its concentration in the solution within
the pocket, the surface area of membrane 70, and the rate of
passage of the membrane to agent. In any event, that rate is
independent of the overall flow rate of intravenous fluid through
chamber 25. Accordingly, the agent is formulated in situ within
chamber 25 and it is administered to the patient at a rate that is
dependent upon the characteristics of the device. The microporous
membrane 70 may be useful also to prevent agent particles from
entering the flow path, and for providing an extra margin of safety
against microorganisms, in the event any may have survived the
sterilization procedure for the system.
FIG. 13 shows another agent formulation chamber, generally
designated 25, in which the dosage form is not in the direct path
of the intravenous fluid flow through the chamber. The chamber is
particularly adapted to hold a plurality of the same or different
delivery devices. The chamber, like those shown in the other
figures, includes a pair of hollow, interfitting housing halves 80
and 81, that have an inlet opening and outlet opening, not shown,
at their respective ends. The inside surface of half 80 carries a
pair of radial flanges 82 and 83, that extend entirely around the
inner circumference of the half. These flanges, together with a
tubular microporous membrane 84 that is attached at its ends to the
flanges, divides the lumen of the chamber into a main intravenous
flow path 85 and an outer concentric pocket 86. A plurality of
agent delivery units 37 are contained within the pocket. Membrane
84 and pocket 86 function in the same manner as membrane 70 and
pocket 75 of FIG. 12. That is, an intravenous fluid flows through
the chamber, water from the fluid diffuses through the membrane
into pocket 86 and causes the device to release agent. The agent
then diffuses from the pocket through the membrane and into the
mainstream of the intravenous fluid flow. In instances in which the
devices are different, it may be desirable to divide pocket 86 into
a plurality of pockets, one for each device. This may be
accomplished with impermeable axial partitions, not shown, that
extend between the inner surface of the half, the membrane, and the
two flanges. In such instances it may be also desirable to have
membrane 84 formed from segments of different microporous
materials, each segment covering a separate pocket. In this manner
different release rates of different agents into the passing
intravenous fluid may be effected.
This novel invention uses means for the obtainment of precise
control of agent release into an intravenous therapeutic system.
While there has been described and pointed out features of the
invention as applied to presently preferred embodiments, those
skilled in the art will appreciate that various modifications,
changes, additions, and omissions in the system illustrated and
described can be made without departing from the spirit of the
invention.
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